Med Surg 2 Exam 3

Treatment of metoprolol overdose

Lavage, IV atropine for bradycardia, IV theophylline for bronchospasm, digoxin, O2, diuretic for cardiac failure, hemodialysis, administer vasopressor

The nurse is performing an admission assessment on a patient with a history of myocardial infarction. Which signs and symptoms of left-sided heart failure should the nurse look for? -cyanosis of the lips -dry cough -pulmonary crackles

Left- sided heart failure symptoms are caused by a diminished ability of the left ventricle to pump blood This leads to back pressure in the pulmonary circulation, causing pulmonary edema, Signs and symptoms of left-sided heart failure include dry cough, crackles, cyanosis, dyspnea, and tachycardia

The nurse is caring for a patient who underwent an angioplasty of the iliac artery. In order to assess for bleeding, the nurse should...

Measure the abdominal girth Internal bleeding may develop and accumulate in the retroperitoneal space Measuring abdominal girth is the best way to assess blood accumulation

Mobitz type 1 block

Mobitz type 1 heart block, also known as Wenkebach, involves prolonged PR intervals followed by blocked P waves (this results in a dropped QRS complex) an unstable rhythm that is usually caused by a ventricle muscle disturbance first-degree atrioventricular block the most severe form of heart block that carries a bad prognosis No treatment is indicated unless the patient is experiencing symptoms, however recognizing this rhythm is important because of conduction blocks is based on the type and degree

MI emergency treatment

Morphine Oxygen Nitroglycerin Aspirin ensure bed rest and place the client in a semi-Fowler's position to enhance comfort and tissue oxygenation; stay with the client Establish an IV access route

A patient is seen in the emergency room for an acute myocardial infarction. The patient's chest began around 11am after doing morning chores. By 1 PM, the pain did not improve, so the patient came to the emergency room. The nurse anticipates that they physician will order.

Nitroglycerin, aspirin, and tissue plasminogen activator (rtPA) incorrect: atropine is indicated for symptomatic bradycardia and is contraindicated in the setting of myocardial infarction due to increasing oxygen demand

While evaluating an EKG during a routine physical exam, the nurse notes that the patient's heart rate is 62 beats per minute with a p wave for every QRS complex and that these are occurring in regular intervals. The nurse determines that the rhythm is normal sinus rhythm, indicating that the heartbeats are following the normal electrical conduction route originating in which of the following? -AV node -Bundle of His -Perkinje Fibers -SA node

Normal sinus rhythm originates in the SA node sino means sinus atrial means from the atria which are the upper heart chambers The SA node is located in the upper area of the right atrium Electrical impulses in the heart normally originate in the SA node, then travel to the AV node, then to the bundle of His down both bundle branches, and along the Perkinjie fibers, which then stimulate the ventricles to contract The large size of the ventricles requires more electrical impulse to cause contraction, which is why the Perkinjie fibers spread out along both ventricles. This is similar to how your car requires a larger battery charge than your flashlight

S3 Heart Sound

Occurs early in diastole as the mitral and tricuspid valves open and blood rushes into the ventricles. To distinguish an S3 from a physiologic S2 split, a split occurs during inspiration and S3 remains constant during the respiratory cycle. Its pitch is softer and best heard with the bell at the apex and it is one of the first clinical findings in the left ventricular failure. An S4 is heard in late diastole when atrial contraction pumps volume into a staff, non compliant ventricle. An S4 is not heard in a client with atrial fibrillation because there is no atrial contraction. Murmurs are sounds created by turbulent blood flow though an incompetent or stenotic valve.

Split S1

Occurs when the closure of the mitral valve is slightly delayed this is caused by a dysfunction in conduction

Pharmakokinetics of nitroglycerin

Onset 1-3 min, duration 30 min Metabolized by liver

PSVT

Paroxysmal supraventricular tachycardia (PSVT) is a faster-than-normal heart rate. The term paroxysmal means that it only happens from time to time. In the case of PSVT, the rapid heart rate can last from a few minutes to several hours.

PEEP

Positive end-expiratory pressure (PEEP) is the pressure in the lungs (alveolar pressure) above atmospheric pressure (the pressure outside of the body) that exists at the end of expiration.

PVC

Premature Ventricular Contraction

Infective endocarditis- RBC

RBC count decreases

Atrial Fibrillation- EKG

Rhythm- irregularly irregular Rate- 120-180 QRS Narrow P Waves/ PR Interval: not present- chaotic fib waves- not measurable

Atrial flutter

Rhythm- regular Rate- 60-180 QRS- Narrow P- Waves/ PR Interval- saw tooth- shaped flutter "F" waves in groups of 3:1 or 4:1 (not true P waves)- not measurable

Normal sinus rhythm

Rhythm- regular Rate- 60-100 QRS- Narrow P- Waves/ PR interval- present normal

Second degree AV block (MOBITZ type 2)

Rhythm: Irregular Rate: 40-100 QRS: Narrow, usually P-Waves/ PR interval: Present, precede each QRS until dropped beat, constant interval

A patient has been diagnosed with left-sided congestive heart failure, and is confused about return of oxygenated blood from the lungs. To clarify the confusion, the nurse explains all chambers of the heart dealing with blood circulation. The nurse is correct when telling the client:

The blood flows into the left ventricle which pumps it out against high resistance into the systemic circulation The left atrium receives oxygenation blood from the lungs The right atrium receives deoxygenated blood from the body tissues

The nurse should assess the client with left-sided heart failure for which of the following? - Dyspna -decreased oxygen saturation levels -Oliguria -Crackles

These are all signs and symptoms related to pulmonary congestion and inadequate tissue perfusion associated with left- sided heart failure

The nurse is caring for a patient at risk for PVCs While monitoring the patients EKG rhythm, the nurse should look for

Wide QRS complexes in the absence of P waves absence of P waves, usually followed by a fully compensated pause PVCS may increase with anxiety, stress, use of alcohol, stimulant medication, hypoxia, or electrolyte abnormalities PVCs are caused by abnormal automaticity of ventricular cells and are very common. They may occur erratically or at regular intervals

lipoprotein a

a modified form of LDL increases atherosclerotic plaques and increases clots; value should be less than 30mg. DL

Nitroglycerin in MI treatment

a potent vasodilator and is commonly used for myocardial infarctions to increase blood flow and oxygen to the myocardium.

Myoglobin

a protein that is present in both heart and skeletal muscles Lactate dehydrogenase (LDH) is an enzyme found in almost all cells of the body, so this makes it the least specific of all the tests for MI

Implantable cardioverter defibrillator (ICD)

a shock may possibly be felt but would not cause harm to the spouse

Most common complication of abdominal aortic aneurysm repair

acute renal failure During a repair of an abdominal aortic aneurysm, a stent graft is placed in the aorta to support the lumen and reduce pressure on the aneurysm sac - if the stent is placed correctly it could block the renal arteries and cause renal failure - the procedure itself may temporarily reduce blood flow to the renal arteries and cause damage and temporary failure of the kidneys -hemorrhage is more common before the AAA repair if the aneurysm ruptures - emboli and infection are also possible complications of an AAA repair, but they are less common than renal failure

clients with coronary artery stents

acute thrombosis is a major concern following the prcedure; the client is placed on antiplatelet therapy such as clopidogrel (Plavix) and acetylsalicylic acid (aspirin) for several months following the procedure length of antiplatelet therapy is determined by the type of stent that has been deployed monitor for complications of the procedure such as stent migration or occlusion, coronary artery dissection, and bleeding resulting from anticoagulation

blood glucose level/ cardiac

an acute cardiac episode can elevate the blood glucose level

Homocysteine

an amino acid that has been shown to be increased in many people with atherosclerosis Clients with elevated levels of homocysteine may have increased risk of CVD. This considered a non-traditional risk factor.

Cardiac catheterization

an invasive test involving insertion of a catheter into the heart surrounding the vessels obtains info about the structure and performance of the heart chambers

angina

chest pain resulting from MI caused by inadequate myocardial ischemia caused by inadequate myocardial blood and oxygen supply

DASH DIET

diet with whole grains (6-8 daily servings) nuts, seeds, and legumes (4-5 per week) lean meats, poultry and fish (6 or fewer servings per day) and sweets that are low in fat

meds discontinued before CABG

digoxin (12 hours) aspirin/ anticoagulants- 1 week before diuretcs- 2 to 3 days before surgery

transeosophageal echocardiography

done through the esophagus invasive exam and requires pre- and postprocedure prep similar to an endoscopy

blood urea nitrogen

elevated in heart disorders that adversely affect renal circulation, such as heat failure and cardiogenic shock

Homocysteine

elevated levels may increase the risk of cardiovascular diseases; level should be less than 14mmol/ dL

Echocardiography

heart chamber size is measured, ejection fraction is calculated, and flow gradient across the valves is determined

Risk factors for primary hypertension

high salt and fat intake, obesity, stress, alcohol consumption, inactivity, caffeine, and vitamin D deficiency

C reactive protein

highly sensitive detects an inflammatory process such as that associated with the development of atherothrombosis; a level less than 1mg dL is considered low risk and a level over 3mg dL places the client at risk for heart disease

Calcium

hypocalcemia can cause ventricular dysrhythmias, prolonged st and qt intervals and cardiac arrest

WBC count after an MI

infectious and inflammatory diseases of the heart and after myocardial infarction (MI) because large numbers of white blood cells are needed to dispose of the necrotic tissue resulting from the infarction

Right sided heart catheterization

inserted into the femoral vein and advanced into the inferior vena cava, right atrium, right ventricle and into pulmonary artery

percutaneous transluminal coronary angioplasty

invasive- non surgical balloon is inserted to open vessel lumen one or more arteries are dilated improves arterial blood flow

Lipid Profile

lipid profile measures serum cholesterol, triglyceride and lipoprotein levels The lipid profile is used assess the risk of developing coronary artery disease

preprocedure for PTCA

maintain NPO status after midnight obtain informed consent, allergy assessment to iodine and withhold metformin (as for cardiac cath) prepare the groin area with antiseptic soap and shave per institutional procedure and as prescribed assess baseline vital signs and peripheral pulses chest pain may occur during balloon inflation and to report it if it does occur

Digitalis is always dosed in

micrograms- mcg

postprocedure for PTCA

monitor vitals assess distal pulses in both extremities maintain bed rest- keep limb straight for 6-8 hours administer anticoagulants such as intravenous heparin and antiplatelet agents to prevent thrombus formation IV nitro may be prescribed to prevent coronary artery vasospasm encourage fluids instruct client: nitrates, calcium channel blockers, antiplatelet agents and aticoagulants as prescribed instruct the client to take acetylsalicylic acid (aspirin) daily permanently if prescribed

Mitral valve stenosis

narrowing of the mitral orifice and thickening of the mitral valve leaflets, which impedes blood flow into the left ventricle. Blood picks up oxygen in the lungs and re-enters the heart into the left atrium, then must pass through the narrowed and thickened mitral valve into the left ventricle of the heart The left ventricle is the main chamber, which pumps oxygen- rich blood to the body through the aorta As blood strains to pass through the mitral valve, pressures rise in the left atrium and then in the lungs, where the blood meets vascular resistance as it backs up. This causes pulmonary congestion and shortness of breath, which is worse with activity (as oxygen need increase) If untreated, the pressure and the fluid build-up in the lungs increases the workload of the right side of the heart, which has to pump harder to send blood into the lung to be oxygenated Over time, right- sided heart failure develops Complications include secondary pulmonary hypertension, atrial fibrillation, and thrombus

qt interval

normally .32- .4 second but varies with the clients age and gender

pulmonary artery wedge pressure

normally ranges between 4 and 12 mm hg elevations may indicate hypovolemia or afterload reduction obtained during momentary balloon inflation of the pulmonary artery catheter and is reflective of left ventricular end- diastolic pressure

VAP prevention

oral care sterile technique

Myoglobin

oxygen binding protein found in cardiac and skeletal muscle the level rises within 2 hours after cell death- rapid decline after 7 hours

Claudication

pain that occurs in the extremities due to the limited blood flow and resultant tissue hypoxia in the legs Exercise typically exacerbates symptoms

coronary artery bypass grafting

performed when client does not respond to medical management of coronary artery disease or when vessels are severely occluded

Atrio-Ventricular valves

prevent ventricle to atrium blood back flow, and they electrically insulate the ventricles from the atria

ekg changes with hypermagnesia

prolonged pr interval and widened qrs complex

normal qrs complex duration

ranges from 0.4-.01 second

Sodium

serum sodium level decreases with the use of diuretics decreases in heart failure indicating water excess

hypercalcemia

shortened st segment and widened t wave

ventricular repolarization

t wave

ekg changes with hypomagnesia

tall t waves and depressed st segments

IVC filter

traps blood clots- implanted in the inferior vena cava and used to trap emboli floating in the vena cava

MI labs

troponin creatine kinase level ck-mb isoenzyme myoglobin wbcs

indications for PTCA

used for clients with evolving MI alone or in combo with meds to achieve reperfusion reoclussion can occur- procedure may need to be repeated

coronary artery stents

used in conjunction with PTCA to provide a supportive scaffold to eliminate the risk of acute coronary vessel closure and to improve long-term patency of the vessel balloon inflation deploys the stent and is positioned at the sight of occlusion when placed in the coronary artery, the stent reopens the blocked artery

Aspirin in MI treatment

used to inhibit platelets and further thrombus formation for any patients with MI unless contraindicated

CK-MB

used to test for cardiac damage but is also present in small amounts in skeletal muscle and it peaks in 12-24 hours, so it is not the best taste to use

Split S2

when the pulmonary valve closes slightly after the aortic valve This normally occurs on inspiration, due to the increased pressure in the pulmonary circulation. It may also be caused by septal defects, pulmonary stenosis, or other abnormalities.

ventricular tachycardia

wide QRS waveforms with the absence of P waves, accompanied by an elevated rate at 100 indicates ventricular tachycardia a low potassium level can cause ventricular irritability, which may lead to ventricular arrhythmias in v-tach, the patient can be awake/ alert but may have shortness of breath and chest pain. Patients in v tach may also be unconscious or lose consciusness during an episode of v- tach v tach is an urgent or emergent situation

Right sided heart failure

- JVD - right upper quadrant pain along with ascites and edema are usually associated with congestion of the peripheral tissues and viscera in right-sided heart failure

postop peripheral arterial revascularization

- assess vitals and peripheral pulses -insert an iv line and urinary cath as prescribed -maintain central venous catheter/ arterial line

cardiogenic shock treatment

-iv morphine -oxygen -prep for intubation and mechanical ventilation -administer diuretics and nitrates as prescribed while monitor the BP constantly -administer vasopressors and positive inotropes to maintain organ perfusion -prep client for insertion of an intra-aortic balloon pump, if prescribed, to improve coronary artery perfusion and improve cardiac output -prep the client for immediate reperfusion procedures such as PTCA or coronary artery bypass graft -monitor arterial blood gas levels and prep to treat imbalances -monitor urinary output

interventions for endocarditis

-provide adequate rest balanced with activity to prevent thrombus formation -antiembolism stockings -monitor cardiovascular status -monitor for signs of heart failure -monitor for signs of emboli -splenic emboli- abdominal pain radiating to left shoulder -clubbing of fingers -administer iv antibiotics

Good dental care is an important measure in reducing the risk of endocarditis. A teaching plan to promote good dental care in a client with mitral stenosis should include instructing the client to which of the following? Select all that apply: 1) Brush the teeth at least twice a day 2) Avoid the use of an electric toothbrush 3) Take an antibiotic prior to oral surgery 4) Floss the teeth at least once a day 5) Have a regular dental checkups 6) Rinse the mouth with an antibiotic mouthwash once a day

1) Brush the teeth at least twice a day 4) Floss the teeth at least once a day 5) Have a regular dental checkups Daily dental care including brushing the teeth twice a day and flossing once a day and frequent checkups by a dentist who is informed about the client's condition are require to maintain good oral health. Taking antibiotics prior to certain dental procedures is recommended only if the client has a prosthetic valve or a heart transplant.

The client is admitted to the telemetry unit due to chest pain. The client has polysubstance abuse, and the nurse assesses that the client is anxious and irritable and has moist skin. The nurse should do the following in which order from first to last?

1) Position electrodes on the chest 2) Take vital signs 3) Administer the prescribed dose of morphine 4) Obtain a history of which drugs the client has used recently

A client has been admitted to the coronary care unit. The nurse observes third-degree heart block at a rate of 35 bpm on the client's cardiac monitor. The client has a blood pressure of 90/60. The nurse should take which of the following actions first? 1) Prepare for transcutaneous pacing 2) Prepare to defibrillate the client at 200J 3) Administer an IV lidocaine infusion 4) Schedule the operating room for insertion of a permanent pacemaker

1) Prepare for transcutaneous pacing Transcutaneous pacemaker therapy provides an adequate heart rate to a client in an emergency situation. Defibrillation and a lidocaine infusion are not indicated for the treatment o third degree heart block used temporarily until a permanent pacemaker can be inserted

An older adult has chest pain and shortness of breath. The health care provider prescribes nitroglycerin tablets. What should the nurse instruct the client to do? 1) Put the tablet under the tongue until it is absorbed 2) Swallow the tablet with 120 mL of water 3) Chew the tablet until is is dissolved 4) Place the tablet between the cheek and gums until it disappears

1) Put the tablet under the tongue until it is absorbed The client is having symptoms of a myocardial infarction. The first action is to prevent platelet formation and block prostaglandin synthesis. The client should place the tablet under the tongue and wait until it is absorbed. Nitroglycerin tablets are not effective if chewed, swallowed, or placed between the cheek and gums.

cardiogenic shock assessment

1) hypotension: BP lower than 90 mmhg systolic or 30 mm hg lower than the clients baseline 2) urine output lower than 30 ml/ hr 3) cold/clammy skin 4) poor peripheral pulses 5) tachycardia 6) pulmonary congestion 7) tachypnea 8) disorientation, restlessness, and confusion 9) continuing chest discomfort

The nurse is caring for a patient complaining of chest pain related to pericarditis. To help relieve the pain, the nurse should instruct the patient to 1) lean forward while sitting 2) lie in the dorsal recumbent position 3) lie in the prone position 4) lie in the supine position

1) lean forward while sitting Pericarditis is inflammation of the pericardium caused by infections, autoimmune disorders, or trauma Instructing the patient to lean forward will pull the heart away from the lungs, preventing pericardial irritation caused by friction and contact with the lungs

treatment for pulmonary edema

1) place client in high fowlers position 2) administer oxygen 3)assess the client quickly; including assessing lung sounds 4) ensure an iv access device is in place 5) prepare for administration of a diuretic and morphine sulfate 6) insert a foley catheter as prescribed 7) prepare for intubation and ventilator support, if required 8) document the event, actions taken, and the clients response

The nurse is assessing the cardiac rhythm of a patient with coronary artery disease (CAD). The heart monitor shows isolated premature ventricular contractions (PVC). What should the nurse do next? 1- Continue to monitor the patient's rhythm 2-Notify the provider immediately 3-Prepare for cardioversion 4-Prepare to administer an antiarrhythmic

1- Continue to monitor the patient's rhythm Isolated PVCs are not life-threatening, but should be monitored closely for other rhythm changes that may follow Atrial fibrillation may develop in someone with frequent PVCs. Other life-threatening arrhythmias such as ventricular fibrillation and ventricular tachycardia are less common, but possible.

A client receiving a loop diuretic should be encouraged to eat with of the following foods? Select all that apply. 1) Angel food cake 2) Banana 3) Dried fruit 4) Orange juice 5) Peppers

2) Banana 3) Dried fruit 4) Orange juice Hypokalemia is a side effect of loop diuretics. Bananas, dried fruit, and oranges are examples of food high in potassium.

A nurse on the cardiac telemetry floor is monitoring the EKG of a patient admitted with an elevated heart rate The nurse notes that the EKG shows an atrial rate of 300 with the P waves in a "saw-tooth" pattern The AV conduction ration is 3:1 with a ventricular response rate of 100. The nurse knows this rhythm is which of the following? 1- Atrial fibrillation 2-Atrial flutter 3-Paroxysmal atrial tachycardia 4-Supraventricular tachycardia

2- Atrial flutter Occurs due to a circular pathway in the right atrium where the SA node is located The electrical impulse conducts through the cells that are polarized and ready to receive an impulse, resulting in continual re-firing. The AV node will not conduct each of these impulses to the ventricles, so ventricular depolarization stays constant. The result is the appearance of "flutter" P waves with normal QRS waves Conduction ratio is calculated based on the number of flutter waves for each QRS wave

INR- patient on Coumadin

2-3

The nurse is caring for a patient with unstable ventricular tachycardia who is undergoing immediate synchronized cardioversion. After two unsuccessful shocks, the patient becomes pulseless. What is the nurse's priority action? 1- Initiate transcutaneous pacing 2-Initiate unsynchronized defibrillation 3-Prepare to adminster magensium sulfate 4-Synchronize the precordial shock

2-Initiate unsynchronized defibrillation If a patient becomes pulseless during synchronized cardioversion, immediate unsynchronized defibrillation should occur.

A patient presents in the emergency room (ER) with complaints of chest pain. The EKG shows regular PR interval with QRS wave missing every third beat. The nurse evaluates the EKG and recognizes this rhythm as which of the following? 1) First degree AV block 2) Mobitz type 1 second degree AV block 3) Mobitz type 2 second degree AV block 4) Third degree AV block

3) Mobitz type 2 second degree AV block In a mobitz type 2 second degree AV block, the blockage of electrical impulses occurs below the AV node, either in the Bundle of His or one of the bundle branches Each time the conduction is blocked, it causes the ventricles to skip a contraction, leading to the missing QRS waves on the EKG The PR interval remains steady because the electrical impulse travels normally through the AV node but is blocked further along in the conduction pathway

A client with chronic failure has atrial fibrillation and a left ventricular ejection fraction of 15%. The client is taking warfarin (Coumadin). The expected outcome of this drug is to 1) Decrease circulatory overload 2) Improve the myocardial workload 3) Prevent thrombus formation 4) Regulate cardiac rhythm

3) Prevent thrombus formation Coumadin is an anticoagulant, which us used in the treatment of atrial fibrillation and decreased left ventricular ejection fraction (less than 20%) to prevent thrombus formation and release of emboli into the circulation The client may also take other medication as needed to manage the heart failure. Coumadin does not reduce circulatory overload improve myocardial workload. Coumadin does not affect cardiac rhythm.

Crackles heard on lung auscultation indicate which of the following? 1) Cyanosis 2) Bronchospasm 3) Airway narrowing 4) Fluid- filled alveoli

4) Fluid- filled alveoli Crackles are auscultated over fluid- filled alveoli. Crackles heard on lung auscultation do not have to be associated with cyanosis. Bronchospasm and airway narrowing generally are associated with wheezing sounds.

Alteplase recombinant or tissue plasminogen activator (t-PA) a thrombolytic enzyme is administered during the first 6 hours after onset of MI to: 1) Control chest pain 2) Reduce coronary artery vasospasm 3) Control the arrhythmias associated with MI 4) Revascularize the blocked coronary artery

4) Revascularize the blocked coronary artery The thrombolytic agent t-PA, administered intravenouly, lyses the clot blocking the coronary artery. The drug is most effective when administered within the first 6 hours after onset of MI. The drug does not reduce coronary artery vasospasm Nitrates= vasodilation

The nurse is auscultating the heart of a patient with congestive heart failure- the nurse hears an extra sound with a very low- pitch, immediately after second heart sound (S2). The nurse interprets this as 1- a murmur due to aortic regurgitation 2-a split S1 3- a split S2 4- a third heart sound (S3)

4- a third heart sound (S3) S3 occurs immediately after S2. It has a very low pitch compared to the S2 and has a been described as a ventricular gallop. It can occur normally in people under 40 and in athletes. Later in life, it may indicate heart failure (ventricular dysfunction) and/ or fluid overload

A nurse is caring for a client who has dilated cardiomyopathy. The client reports increasing difficulty completing her daily 1- mile walks. The nurse should recognize that this is a finding of which of the following? A) Left ventricular failure B) Peripheral vasodilaton

A) Left ventricular failure- activity intolerance is a finding of left ventricular failure and is associated with dilated cardiomyopathy Peripheral vasodilation is not a finding associated with dilated cardiomyopathy Pericardial effusion is not a finding associated with dilated cardiomyopathy Decreased vascular volume is not a finding associated with dilated cardiomyopathy

The most effective measure the nurse can use to prevent wound infection when changing a client's dressing after coronary artery bypass surgery is to: A) Observe careful hand-washing procedures B) Clean the incisional area with an anti-septic C) Use prepackaged sterile dressings to cover the incision D) Place soiled dressings in a water

A) Observe careful hand-washing procedures Many factors help prevent wound infections, including washing hands carefully, using sterile prepackaged supplies and equipment, cleaning the incision area well, and disposing of soiled dressings properly. However, most authorities say that they single most effective measure in preventing wound infections is to wash the hands carefully before and after changing dressings. Careful hand washing is also important in reducing other infections often acquired in hospitals, such as urinary tract and respiratory tract infections.

The nurse is teaching a client with hypertension about taking atenolol (Tenormin). The nurse should instruct the client to: A)Avoid sudden discontinuation of the drug B) Monitor the blood pressure annually C) Follow a 2-g sodium diet D) Discontinue the medication if severe headaches develop

A)Avoid sudden discontinuation of the drug Atenolol is a beta-adrenergic antagonist indicated for management of hypertension. Sudden discontinuation of this drug is dangerous because it may exacerbate symptoms. The medication of should not be discontinued without a physician's prescription. pressure needs to be monitored more frequently than annually in a client who is newly diagnosed with hypertension. Clients are not usually placed on a 2g sodium diet for hypertension.

P Wave

Atrial Depolarization

Non-traditional risk factors for CVD

C- Reactive Protein Homocysteine

Side effects of nitroglycerin

CNS: Headache, flushing, dizziness CV: Postural hypotension, tachycardia, collapse, syncope, palpitations GI: Nausea, vomiting Integumentary: Pallor, sweating, rash

The nurse has completed an assessment on a client with a decreased cardiac output. Which findings should receive the highest priority?

Confusion, urine output 15 mL over the last 2 hours, orthopnea. A low urine output and confusion are signs of decreased tissue perfusion. Orthopnea is a sign of left- sided heart failure. Crackles, edema, and weight gain should be monitored closely, but the levels are not as high a priority. With atrial fibrillation, there is a loss of atrial kick, but the blood pressure and heart rate are stable.

CPAP

Continuous Positive Airway Pressure- a type of ventilator therapy

What is the most common cause of heart failure?

Coronary Artery Disease- reduced blood flow through the coronary arteries and therefore reduces oxygen delivery to the myocardium

Diagnosis a DVT

Diagnostic tests that can help diagnose a DVT include a D-dimer test to confirm the presence of fibrin degradation products forma clot, venous ultrasound, venography to visualize the clot with contrast, or less commonly, magnetic resonance imaging (MRI) or computer tomography (CT)

The nurse assessing a patient with atrial fibrillation and a rapid ventricular rate. The nurse would expect to see...

Dizziness and hypotension the atria initiate rapid, ineffective contractions that are not synchronized with the ventricular contractions the patient has uncontrolled atrial fibrillation, which can result in a low cardiac output Signs and symptoms of low cardiac output include hypotension, dizziness,weakness, fatigue, shortness of breath, and syncope

MI EKG Findings

Elevated ST waves MI STEMI, T-wave inversion, or non-ST elevatin MI NSTEMI; an abnormal Q wave may also be present

Complication of balloon valvuloplasty - cardiac cath

Emboli resulting in a stroke Client's increased drowsiness should be evaluate Some degree of mitral regurgitation is common after the procedure

Signs and Symptoms of endocarditis FROM JANE

Fever Roth's spots Osler's nodes Murmur Janeway lesions Anemia Nail hemorrhage (splinter hemorrhages) Emboli

Pharmacokinetics of Metoprolol

Half-life 3-4 hr, metabolized in liver (metabolites), excreted in urine, crosses placenta, enters breast milk PO: Peak 2-4 hr, duration 13-19 hr PO-ER: Peak 6-12 hr, duration 24 hr IV: Onset immediate, peak 20 min, duration 6-8 h

Metoprolol Dosage for Hypertension

Hypertension • Adult: PO 50 mg bid or 100 mg/day; may give up to 200-450 mg in divided doses; EXT REL 25-100 mg daily, titrate at weekly intervals; max 400 mg/day

Secondary hypertension

Identifiable causes which include but are not limited to renal disease, Cushing's syndrome, hyperthyrodisim, hyperaldosteronism, pheochromocytoma, hormonal contraceptives, and diabetes

C- Reactive Protein

An independent risk factor for CVD Research has focused on the use of C-reactive protein as an inflammatory marker for CVD

A nurse is caring for a client who is schedule for a coronary artery bypass graft (CABG) in 2 hr. Which of the following client statements indicates a need for further clarification by the nurse?

"I took my warfarin last night according to my usual schedule" Clients scheduled for a CABG should not take anticoagulants, such as warfarin, for 5-7 days prior to the surgery to prevent excessive bleeding

Electrocardiography

- common noninvasive diagnostic test records the electrical activity of the heart useful for detecting cardiac dysrhythmias, location and extent of MI, and cardiac hypertrophy and for evaluation of the effectiveness of cardiac medications speed of 25mm/ second small square= 0.04 second large square represents 0.20 secods

A patient is admitted to the cardiac unit with endocarditis. The patient asks how someone catches the illness. Which of the following should the nurse include when explaining risk factors of endocarditis to the patient?

- dental procedures -history of mitral valve replacement -history of rheumatic fever endocarditis is an infection or inflammation of the inner lining of the heart, known as the endocardium the major risk factors for endocarditis include mechanical heart valve replacement, rheumatic fever, dental procedures, IV drug use, and immunosuppression heart valves do not receive a dedicated supply of blood. This results in a blunted immune response to valve infections. Microbes can therefore attach to the surface of a valve and form a vegetation without a significant response from the body

Left- Sided Heart Failure

-Formerly known as congestive heart failure -Typical causes: - Hypertension - Coronary artery disease -Valvular disease Not all cases involve fluid accumulation Two types: Systolic/ Diastolic

Nurse notes that the PR interval is growing increasingly prolonged before each QRS,. The the nurse notes that a p-wave occurs with no QRS present. The nurse recognizes the rhythm as 1) first degree AV block 2) Mobitz type 1 second degree AV block 3) Mobitz type 2 second degree AV block 4) Third degree AV block

2) Mobitz type 1 second degree AV block

A patient is brought to the emergency department with complaints of chest pain radiating to the shoulder and shortness of breath. Which of the following lab tests is most important to obtain and evaluate? 1- Creatinine Kinase (CK-MB) 2-Lactate dehydrogenase 3-Myoglobin 4-Troponin- I

4-Troponin- I Highly specific for cardiac muscle necrosis and is the most accurate lab test for myocardial infarctions. It rises in 3-4 hours and can be detected for up to 10-14 days. Of note, an electrocardiogram (EKG) is also one of the first tests ordered for patients with a suspected myocardial infarction (MI)

When teaching a client with heart failure about preventing complications and future hospitalizations, which problems stated by the client as reasons to call the physician would indicate to the nurse that the client has understood the teaching? Select all that apply. A) Becoming increasingly short of breath at rest B) Weight gain of 2lb (0.9kg) or more in 1 day C) High intake of sodium for breakfast D) Having to sleep sitting up in a reclining chair E) Weight loss of 2lb (0.9lb) in 1 day

A) Becoming increasingly short of breath at rest B) Weight gain of 2lb (0.9kg) or more in 1 day D) Having to sleep sitting up in a reclining chair These suggest worsening of the client's heart condition

A nurse is caring for a client who has heart failure and is experiencing atrial fibrillation. The nurse should plan to monitor for and report which of the following findings to the provider immediately? A) slurred speech B) irregular pulse C) Dependent edema D) Persistent fatigue

A) Slurred speech The greatest risk to this client is injury fro an embolus caused by the atrial fibrillation. Slurred speech can indicate inadequate circulation to the brain because of an embolus. The nurse should report this finding to the provider immediately. An irregular pulse, an expected finding for a client who has atrial fibrillation, indicates the client is at risk for inadequate cardiac output, but another finding is the priority.

When caring for a patient with mitral valve stenosis, the nurse should monitor for which of the following symptoms associated with this condition?

Blood-tinged sputum Edema in the legs Fatigue

A nurse providing teaching for a client who is 2 days postoperative following a heart transplant. Which of the following statements should the nurse include in the teaching? A) You may no longer be able to feel chest pain B) Your level of activity intolerance will not change C) The client will need to permanently maintain a diet that is restricted to sodium and fat D) The client will remain on immunosuppressants for the remainder of his lief to prevent rejection of the heart

A) You may no longer be able to feel chest pain Heart transplant clients usually are no longer able to feel chest pain dye to denervation of the heart The client's activity tolerance should gradually improve as the healing process progresses The client will need to permanently maintain a diet that is restricted in sodium and fat The client will remain on immunosuppressants for the remainder of his life to prevent rejection of the heart

Effects of metoprolol on lab values

BUN, potassium, ANA titer, serum lipoprotein, triglycerides, uric acid, alk phos, LDH, AST, ALT

Metoprolol

Beta- Blocker- Anti Hypertensive/ Anti-Anginal Action: Lowers B/P by β-blocking effects; reduces elevated renin plasma levels; blocks β2-adrenergic receptors in bronchial, vascular smooth muscle only at high doses; negative chronotropic effect Uses: Mild to moderate hypertension, acute MI to reduce cardiovascular mortality, angina pectoris, NYHA class II, III heart failure, cardiomyopathy

The nurse is admitting a patient suspected of having an acute myocardial infarction. The physician orders lab tests to confirm the diagnosis. An increase in the isoform creatine kinase (CK-MB) is expected how soon after the onset of chest pain? A) 1-.5-2.5 hours B) 1-2 hours C) 4-6 hours D) 8-12 hours

C) 4-6 hours Serum CK-MB levels start to elevate 4-6 hours after the onset of chest pain. Levels usually peak around 12-18 hours after onset of chest pain, then return to normal after 48-72 hours.

A nurse is caring for a client in the first hour following an aortic aneurysm repair. Which of the following findings can indicate shock and should be reported to the provider? A) Serosanguineous drainage on dressing B) Severe pain with coughing C) Urine output of 20ml/ hr D) Increase in temp from 36.8C (98.2F) to 37.5C (99.5F)

C) urine output of 20mL/ hr - urine output less than 30mL/ hr can indicate shock because it reflects decreased blood flow to the kidneys, possibly from graft rupture and hemorrhage Serosanguineous drainage during the first post-op hours is expected and is not a sign of shock Coughing is painful after an aortic aneurysm repair. However, it is not associate with shock. A moderate temp change is not associated with shock

A nurse is reviewing the lab results of several clients who have peripheral arterial disease. The nurse should plan to provide dietary teaching for the client who has which of the following lab values? A) Cholesterol 180 mg/ DL, HDL 70mg/ dL, LDL 90 mg/ DL B) Cholesterol 185 mg/ DL, HDL 50mg/ dL, LDL 120 mg/ DL C)Cholesterol 190 mg/ DL, HDL 25mg/ dL, LDL 160mg/ DL D) Cholesterol 195 mg/ DL, HDL 55mg/ dL, LDL 125 mg/ DL

C)Cholesterol 190 mg/ DL, HDL 25mg/ dL, LDL 160mg/ DL The expected reference range of cholesterol is less than 200mg/ dL, HDL above 40 mg/dL, and LDL less than 100 mg/ DL

Mitral Valve Stenosis

Can lead to heart failure as evidence by an increase in PCO2 levels and a decrease in pO2 Heart failure is a common complication of patients with mitral valve stenosis. This is evident by jugular vein distention, cold clammy skin, tachycardia, orthopnea, increased arterial pCO2, and a decrease in Po2. R Rales may be an indication of pulmonary edema that has developed secondary to the congestive heart failure

The nurse is caring for a patient diagnosed with infective endocarditis. The patient has a history of intravenous (IV) illicit drug use. Physical exam is likely to reveal which of the following? 1-Fever 2-Osler's nodes 3- Splinter Hemorrhages

Common signs and symptoms of infective endocarditis include fever, malaise, murmur, weight loss, splinter hemorrhages, and Osler's Splinter hemorrhages run vertically under the fingernails and are thought to be caused by small clots that damage the capillaries in the nail bed Infective endocarditis most commonly occurs in IV drug users- other risk factors are rheumatic fever, history of heart valve replacement, or dental procedures.

CPAP Vs. PEEP

Continuous positive airway pressure (CPAP) is a form of positive airway pressure ventilator, which applies mild air pressure on a continuous basis to keep the airways continuously open in people who are able to breathe spontaneously on their own. It is an alternative to positive end-expiratory pressure (PEEP

Metoprolol Contraindications

Contraindications: Hypersensitivity to β-blockers, cardiogenic shock, heart block (2nd, 3rd degree), sinus bradycardia, pheochromocytoma, sick sinus syndrome

meds that may be prescribed prior to coronary artery bypass grafting

potassium chloride antihypertensives antidysrhythmics antibiotics

A nurse is reviewing the medical record of a client who is receiving heparin therapy for treatment of deep vein thrombosis. Which of the following interventions should the nurse anticipate taking if the client's aPTT is 96 seconds? A) Increase the heparin infusion flow rate by 2 mL/ hr B) Continue to monitor the heparin infusion as prescribed C) Request a prothrombin time D) Stop the heparin infusion

D) Stop the heparin infusion The aPTT level is above the therapeutic range of 1.5-2 times the control value. The nurse should discontinue the heparin infusion immediately and notify the provider to prevent harm to the client.

A patient takes digoxin for CHF- which of the following early findings on the patients EKG would alert the nurse to possible digoxin toxicity?

Premature ventricular contractions PVCs are the most common EKG abnormality seen in early digoxin toxicity- causes a malfunction in the sodium/ potassium/ATPase pump of the cardiac cell, PVCs Bradycardia is a late symptom of digoxin toxicity

The nurse is assessing a patient scheduled for surgery later today. The patient complaining of chest and shoulder pain, perspiration, and shortness of breath. Which of the following can be done?

Initiate protocol for the MET and notify the physician These symptoms are consistent with an acute MI, whcih is a medical emergency. The hospital or facility should have a protocol in place to assist the nurse for a patient experiencing a suspected MI. The MET team usually has standing orders for blood work, electrocardiogram, oxygen, nitrogen and/ or morphine administration. This workup can begin while the provider is being contacted.

A patient scheduled to undergo a left femoral-popliteal bypass graft has a poor perfusion to the left lower extremity. Due to the poor perfusion, which of the following interventions should the nurse complete before the procedure?

Mark the location of the posterior tibial and dorsal pedal pulses. Due to poor perfusion, the nurse should assess and document evidence of weak peripheral pulses before the surgery to correct this the locations are marked in order to establish a baseline for comparison after the procedure

2nd degree type 1 AV block

Rhythm: irregular Rate: 60-100 QRS: Narrow, usually P-Waves/ PR interval: Progressively longer PR followed by dropped QRS Mobitz type 1 heart block, also known as Wenkebach, involves prolonged PR intervals followed by blocked P waves (this results in a dropped QRS complex)

Right sided heart failure symptoms

Right sided heart failure symptoms are caused by a diminished ability of the right ventricle to pump blood. This causes blood to pool in the extremities, abdomen, neck, and liver. Signs and symptoms of right-sided heart failure include peripheral edema, asciates, jugular vein distention, and hepatomegaly

Microalbuminuria

Small amount of protein in the urine has been a marker for endothelial dysfunction in cardiovascular disease

Which set of postural vital signs (BP and heart rate) indicate inadequate blood volume?

Supine 120/70, 70. Sitting 102/64, 86. Standing 100/60, 92. There was significant change in both blood pressure and heart rate with position change. This indicates inadequate blood volume to sustain normal values. Normal postural changes allow for an increase in heart rate of 5-20 bpm, a possible slight decrease of less than 5 mm Hg in the systolic blood pressure, and a possible slight increase of less than 5 mm Hg in the diastolic blood pressure.

BIPAP vs CPAP

The main difference between BiPAP and CPAP machines is that BiPAP machines have two pressure settings: the prescribed pressure for inhalation (ipap), and a lower pressure for exhalation (epap). The dual settings allow the patient to get more air in and out of their lungs.

Lidocaine Lidocaine (Xylocaine)

Used for PVCs, VT, VF 1-1.5 mg/kg IV bolus, then 0.5-0.75 mg/kg IV boluses every 5-10 min to a loading dose of 3 mg/kg, followed by 2-4 mg/min infusion For VF or pulseless VT: 1-1.5 mg/kg IV bolus every 3-5 min to a loading dose of 3 mg/kg, followed by 1-4 mg/min infusion Watch for confusion, paresthesias, slurring of speech, drowsiness, or seizure activity. CNS adverse effects predominate; they may require a decrease in dosage or discontinuation of the infusion.

Premature atrial contractions

arise from the atria and cause the SA node (the natural pacemaker of the heart) to fire prematurely. While PACs may eventually be seen in a digoxin toxicity this dysrhythmia is not the most frequently seen early dysrhythmia of digoxin toxicity

complications of PTCA

arterial dissection or rupture, embolization of plaque fragments, spasm, and acute MI

teaching for patients with endocarditis

aseptic technique when taking antibiotics monitor temperature daily for up to 6 weeks and report gever encourage oral hygiene twice a day avoid flossing and use a soft tooth brush cleanse skin lacerations thoroughly and apply an antibiotic as prescribed

Chronic congestive heart failure

can easily exacerbate and decompensate commonly results from infections, arrhythmias, hypertension, anemia, hyperthyroidism, inadequate diet, and medications such as NSAIDS

Dysrhythmias

can result from disturbance in automaticity, conduction, conduction, and re-entry of impulses If the SA node fails to fire, in a normal heart, the AV node should take over function the SA node is the pacemaker of the heart

rtPA

can be used to restore perfusion blocked coronary arteries. Fibriolytic therapy is one option for treating acute myocardial infarction when the preferred goal for percutaneous intervention (stent placement) IS NOT AN OPTION. Administration of a "clot buster" to patients who meet criteria including ECG findings is indicated when symptom onset occurs within 12 hours.

high magnesium level

can cause muscle weakness, hypotension, and bradycardia

Hypokalemia

causes increased cardiac electrical instability, ventricular dysrhythmia and increased risk of digoxin toxicity ekg shows flattening and inversion of the t wave- appearance of the u-wave and st depression hyperkalemia causes asystole and ventricular dysrhythmias ekg shows tall peaked t waves, widened qrs complexes, prolonged pr intervals or flat p waves `

Indications for thrombolytics

chest pain more than ten minutes unrelieved by nitro

Hyperkalemia- EKG

elevated serum potassium level -electrolyte imbalance typically causes peaked T waves. not inverted T waves

CK-MB

expressed mainly in heart muscle levels can rise following an infarction, but its elevation has a short duration, so its use is appropriate for acute presentation of recent heart damage. There is a small amount of CK_MB present in skeletal muscle, but if skeletal muscle damage is not present, it is a relatively good indicator of heart damage. If there is skeletal muscle damage (from a multi-vessel intervention (MVI) for example), this test would not be used to detect a heart attack

Referred pain in an MI

felt in an area other than the stimulus during a myocardial infarction, pain is commonly felt in the chest, but pain also refers (or radiates) to the left shoulder or arm, neck, or jaw women usually experience the same chest pain as men, but are more likely than men to have pain in the back and jaw, fatigue, dizziness or lightheadedness, and shortness of breath with nausea or vomiting women can also have no chest pain but feel pressure in the upper back or abdomen women are more likely than men to die from a heart attack

Troponin I

has a high affinity for myocardial injury; rises within 3 hours and persists for up to 7-10 days Normal values are less than 0.6ng/ mL and troponin T lower than 0.1 ng/ mL; thus, any rise can indicate myocardial cell damage

Stress Test

indicated for patients with suspected ischemia who are stable and have no clear diagnosis of acute coronary syndrome. It is used to "rule out" coronary ischemia induced by exercise. inappropriate for a patient with a diagnosed infarction because it increases demand and worsens tissue death.

Endocarditis

inflammation of the inner lining of the heart- typically found in IV drug abusers, patients who have had valve replacements or other valve repairs with prosthetic materials or other structural cardiac defects

preop intervention coronary artery bypass grafting

inform client to expect a sternal incision, possible arm or leg incisions, one or two chest tubes, foley, and several iv fluid catheters endotracheal tube will be in place and he/ she will be unable to speak client will be on a vent post-op pain is expected and pain meds will be available

The nurse is assessing a patient in the emergency room due to chest pain. To determine whether the patient's pain is due to an MI, the nurse should note the pain

is unrelieved by nitroglycerin, but is relieved by morphine Pain from an MI usually lasts longer than 30 minutes, radiates to the left arm and shoulder, and requires morphine for relief because myocardial tissue has died from hypoxia. The onset of chest pain from an MI can begin with activity or exertion, but does not improve with rest or use of nitroglycerin

prominent u wave on ekg

may indicate an electrolyte abnormality such as hypokalemia

MAP

mean arterial pressure approximation of pressure in the systemic circulation throughout the cardiac cycle; used in hemodynamic monitoring must be between 60-70 mm HG for adequate organ perfusion

The nurse is caring for a patient that suddenly goes into uncontrolled atrial fibrillation. To determine if the patient has an adequate stroke volume, the nurse would assess for

pulse deficit occurs when the apical pulse is greater than the radial pulse- this is due to a low stroke volume in which most of the blood flow is not reaching the periphery

central venous pressure

reflects pressure within superior vena cava and measures blood returned to superior vena cava and right atrium measured with a central venous line normal is about 3-8 mm hg

B type natriuretic peptide

released in response to atrial and ventricular stretch- serves as a marker for heart failure BNP levels should be lower than 100 pg/ mL; the higher the level the more severe the heart failure

PR interval

represents the time it takes an impulse to travel from the atria through the av node, bundle of His, and bundle branches of the purkinje fibers 0.12-.2 seconds

cardiac tamponade

restricts ventricular filling and cardiac output drops

Most common cause of mitral valve stenosis

rheumatic heart disease caused by rheumatic fever, which can develop after a strep infection (strep throat)

Sinus tachycardia

rhythm is regular rate is 100-160 QRS is narrow P waves/ PR interval- precede each QRS, normal, constant

Weight is the most reliable indicator of fluid gain/ loss

right-sided heart failure

Risk factors for CVD

sedentary lifestyle, metabolic syndrome, obesity, and diabetes

phosphorous level

should be interpreted with calcium levels because the kidneys retain or excrete one electrolyte in an inverse relationship to the other

CVP on vent

should be taken at the point of end- expiration

beta blockers

slow the heart rate and increase myocardial perfusion while reducing the force of myocardial contraction

Axillofemoral bypass

surgical revascularization procedure used to treat symptomatic aortoiliac occlusive disease for patients who cant undergo aortofemoral intervention The axillary artery is connected via a long flexible graft to the femoral artery below and another graft may shunt blood to the opposite femoral artery in order to restore perfusion to the lower extremities Tell patient not to wear a belt because it would put pressure across the abdomen, possibly occluding the bypass graft and cutting off circulation to the lower extremities

MI- EKG

typically manifests as changes to the ST segment of the patient's EKG, not the T wave

PAD- exercise program

will improve collateral circulation PAD results from compromised blood flow to the extremities Intermittent claudication occurs during activities such as walking, a progressive exercise program improves circulation and collateral blood flow around the affected (blocked) arteries Exercise programs should be progressive. The patient should start with walking or other mild exercises and increase intensity as tolerated

The nurse is explaining risk factors of heart failure to a client. Which of the following risk factors as considered extrinsic factors?

-Coronary artery disease -Diet and weight -hypertension -pregnancy Extrinsic factors are external to the heart that place excessive demands upon the heart, and can contribute to heart failure. High blood pressure forces the heart to work harder to eject blood. The heart eventually fails after prolonged high pressures Pregnancy increases the body's demands for oxygen and is an extrinsic factor affecting heart failure. The workload on the heart increases in an effort to move blood. Diets with a high glycemic index (GI) or glycemic load may contribute to the risk of congestive heart failure (CHF), along with a high intake of red meat and high-fat dairy products and obesity

In a patient with hypothyroidism, which clinical manifestation would be indicative of right-sided heart failure? 1) Cyanosis of the fingers 2) Dry cough 3) Leg edema 4) Pulmonary crackles

3) Leg edema

While caring for a patient with severe heart failure and coronary artery disease, the nurse understands that her patient's decreased preload could be caused by 1- fluid overload 2-heart failure 3-heart rate of 55 4-sepsis or hemorrhage

4-sepsis or hemorrhage Preload is determined by how much the muscles of the heart stretch due to the blood volume that has filled the ventricles at the end of diastole. Preload is decreased by conditions that reduce circulating volume or venous return. This includes hemorrhage, sepsis, and anaphylaxis

Following diagnosis of angina pectoris, a client reports being unable to walk up two flights of stairs without pain. Which of the following measures would most likely help the client prevent this problem? A) Climb the steps early in the day B) Rest for at least an hour before climbing the stairs C) Take a nitroglycerin tablet before climbing the stairs D) Lie down after climbing the stairs

C) Take a nitroglycerin tablet before climbing the stairs Nitroglycerin may be used prophylactically before stressful physical activities such as stair climbing to help the patient remain pain free.

A patient with heart failure (HF) due to systolic dysfunction is being education by the nurse on angiotensin- converting enzyme (ACE) inhibitors. The nurse should include which of the following in the discharge teaching? Ace inhibitors can improve your exercise tolerance ACE inhibitors relax blood vessels and can lower blood pressure, making it easier for the heart to pump

ACE inhibitors are the medicines that treat heart, blood vessel, and kidney problems. Some examples include: Catopril, Ramipril, Enalipril, Lisinopril, and Perindopril Though the reasons are not fully understood, numerous trials have found that therapy with ACE inhibitors significantly improves exercise capacity in patients with HF ACE inhibitors improve lung function by increasing alveolar- capillary membrane diffusing capacity and pulmonary vascular function in patients with HF

Blood coagulation factors MI

An increase in coagulation factors can occur during and after an MI- which places the client at greater risk for thrombophlebitis and extension of clots in the coronary arteries

A nurse is monitoring a client following a coronary artery bypass graft surgery. Which of the following findings can indicate cardiac tamponade? A) sternal instability B)Increased WBC count C) Blood pressure 140/82 mm Hg on inspiration and 154/90 mm Hg on expiration D) Sinus rhythm with occasional premature atrial contractions and heart rate 88/min

C) Blood pressure 140/82 mm Hg on inspiration and 154/90 mm Hg on expiration Sternal instability is an expected finding because of the incision through the sternum during surgery An increased WBC Count can indicate an infection Premature atrial contractions with a heart rate within the expected reference range can be caused by caffeine intake and lack of sleep

A nurse is caring for a client who had an onset of chest pain 24 hours ago. The nurse should recognize that an increase in which of the following is a diagnostic of a MI A) Myoglobin B) C- Reactive protein C) Creatine Kinase- MB D) Homocysteine

C) Creatine Kinase- MB: is the isoenzyme specific to the myocardoum and is elevated when that muscle is injured Elevated myoglobin is found after an MI, but it is not specific tot eh cardiac muscle and can increase if other muscles are injured C-reactive protein increases soon after the beginning of an inflammatory process, such as rheumatoid arthritis, and is not specific to cardiac muscle Homocysteine is always present in the blood. An incrased level can be a risk factor marker for the develpment of cardiovascular disease

A nurse is caring for a client who is taking albuterol. For which of the following adverse effects should the nurse monitor the client? A) Hyperkalemia B) Dyspnea C) Tachycardia D) Candidiasis

C) Tachycardia- the nurse should monitor this client for tachycardia, a common adverse effect, especially if the client uses albuterol excessively Hyperkalemia is not an adverse effect of albuterol The client should use albuterol to treat dyspnea Candidiasis is an adverse effect of inhaled glucocorticoids, such as beclomethasone

A nurse in the emergency department is caring for a client who had an anterior myocardial infarction. The client's history reveals she is 1 week postoperative open cholecystectomy. The nurse should recognize that which of the following interventions is contraindicated? A) Administering IV morphine sulfate B) Administering oxygen at 2L/ min via nasal cannula C) Helping the client to the bedside commode D) Assisting with thrombolytic therapy

D) Assisting with thrombolytic therapy - the nurse should recognize that major surgery within the previous 3 weeks is a contraindication for thrombolytic therapy Administering IV morphine is an appropriate intervention for pain management Supplemental oxygen can increase myocardial tissue perfusion and is an appropriate intervention to assist the client Using a bedside commode is less stressful than using a bedpan, and most clients are allowed to use a commode following an infarction

A nurse is preparing a client for a coronary angiography. The nurse should report which of the following findings to the provider prior to the procedure. A) Hemoglobin 14.4 g/ dL B) History of peripheral arterial disease C) Urine output 200 mL/ 4 hr D) Previous allergic reaction to shellfish

D) Previous allergic reaction to shellfish- the contrast medium is iodine-based. Clients who have a history of allergic reaction to shellfish most often react to iodine and might need a steroid or antihistamine A hemoglobin level of 14.4 g/ dL is within the expected reference range This procedure involves access through large arteries or veins into the heart and is not affected by peripheral arterial disease An output of 200mL in 4 hrs is within the expected reference range

A nurse is reviewing a patient's EKG and notes that the T waves appear inverted. The nurses suspect which of the following as the most likely condition? A) hyperkalemia B) hypertension C) Myocardial infarction D) Tissue ischemia

D) Tissue Ischemia Inverted or depressed T waves on the patients EKG indicate tissue ischemia or decreased oxygen to the tissues

Digitalis- Digoxin

Used for CHF, AF, atrial flutter, PSVT Assess apical heart rate for 1 min before each dose. Decreased heart rate is an expected response, but bradycardia may indicate toxicity. Assess for sudden increase in heart rate and change of rhythm from regular to irregular, or irregular to regular. Changes in heart rate or rhythm may indicate toxicity. Teach patients to report anorexia, nausea, vomiting, diarrhea, paresthesias, confusion, or visual disturbances. Side effect can indicate toxicity. Monitor serum potassium levels. Hypokalemia increases the risk for toxicity and ventricular dysrhythmias. Monitor serum creatinine levels. Impaired renal function can cause toxicity; the dosage is altered if this occurs.

A patient with valvular heart disease comes to the emergency department with reports of syncope and dyspnea on exertion. The nurse suspects A) aortic regurgitation B) aortic stenosis C) mitral prolapse D) mitral stenosis

B) aortic stenosis refers to the narrowing of the aortic valve causes reduced cardiac output and increased left ventricle pressure with exertion, the heart cannot increase cardiac output because of a narrow aortic valve. This can cause syncope due to insufficient perfusion to the brain when it needs the extra oxygen. Syncope is a hallmark sign of aortic stenosis

Intrinsic factors- heart failure

Congenital defects (left to right shunts) increase preload, te initial stretching of the cardiac muscle fiber length before contraction. This is one of the intrinsic factors (arising from intrinsic disease or pathology) that can lea to heart failure. Dysrhythmias are one of the intrinsic causes of heart failure, because it arises from within the heart. Other intrinsic factors are valve disease and cardiomyopathy

In which of the following positions should the nurse place a client with heart failure who has orthopnea?

Sitting upright (High- Fowler's position) with legs resting on the mattress ; sitting almost upright in bed with the feet and legs resting on the mattress decreases venous return to the heart, thus reducing myocardial workload. Also, the sitting position allows maximum space for lung expansion. Low Fowler's position would be used if the client could not tolerate high fowler's position for some reason.

Atropine

Used for bradycardia 0.5 mg IV bolus may be repeated every 3-5 min, if necessary, to a maximum of 0.04 mg/kg (total 3 mg) Monitor heart rate and rhythm after administration. Increased heart rate is expected. Assess for chest pain after administration. Increased heart rate may cause ischemia in patients with CAD. Assess for urinary retention and dry mouth after administration. Atropine is an anticholinergic agent. Avoid using in patients with acute angle-closure glaucoma. Atropine increases intraocular pressure.

Holter monitoring

client wears a monitor and ekg tracing is recorded continuously over a period of 24 hours or more while the client performs his or her activities of daily living identifies dysrhythmias if they occur and evaluates the effectiveness of antidysrhytmics or pacemaker therapy maintain a diary documenting activities and any symptoms that may develop for correlation with ecg tracing

Side effects associated with ACE inhibitors

include hypotension, acute renal failure, and hyperkalemia

post cardiac cath

monitor vitals/ cardiac rhythm for dysrhythmias at least every 30 minutes for 2 hours initially - assess for chest pain and if dysrhytmias or chest pain occurs, notify the HCP -notify hcp if the client complains of numbness and tingling, if the extremity becomes cool, pale, or cyanotic, or if loss of the peripheral pulse occurs -monitor the pressure dressing for bleeding or hematoma formation -apply a sandbag or compression device (if-prescribed) to the insertion site to provide additional pressure if required -keep extremity extended for 4-6 hours as prescribed- keep leg straight to prevent arterial occlusion -maintain strict bed rest for 6-12 hours as prescribed; however the client may turn from side to side - do not elevate the head of the bed more than 15 degrees -if antecubital vessel was used, immobilize the arm with an armboard -encourage fluid intake, if not contraindicated to promote renal excretion of the dye to replace fluid loss caused by the osmotic diuretic effect of the dye

Contraindications for thrombolytics

non- stemi patient, recent abdominal surgery, recent stroke, active bleeding, pregnancy, current use of anti-coagulants nursing priorities: report bleeding to md or rapid response team; observe IV sites for bleeding; test emesis and stool for occult blood and document neuro status

pre- cardiac cath

obtain informed consent -assess for allergies to seafood, iodine, or radiopaque dyes- if allergic may be pre-medicated with antihistamines and corticosteroids to prevent a reaction withhold solid food for 6-8 hours and liquids for 4 hours as prescribed to prevent vomiting and aspiration during procedure document the client's height and weight will be needed to determine the amount of dye to be administered -obtain baseline vitals -note quality and presence of peripheral pulses for post-procedure comparison -local anesthetic will be administered before catheter insertion -inform client that he/ she may feel fluttery feeling as the catheter passes through the heart- flushed warm feeling when the dye is injected -prepare insertion site by shaving and cleaning with an antiseptic solution if prescribed -sedatives may be prescribed -IV insertion may be prescribed

wide QRS complexes

ventricular depolarization

low magnesium level

ventricular tachycardia and fibrillatio

Digoxin toxicity

visual changes palpitations or irregular heartbeat can indicate digoxin toxicity Cardiac manifestations of digitalis toxicity can include virtually any type of arrhythmia with the exception of rapidly conducted atrial arrhythmias

Metoprolol Dosage for MI

• Adult:IV BOL (early treatment) 5 mg q2min × 3 then 50 mg PO 15 min after last dose and q6hr × 48 hr; (late treatment) PO maintenance 50-100 mg bid for 1-3 yr

peripheral arterial revascularization

- increase arterial bloodflow to affected limb inflow procedures involve bypassing the arterial occlusion above the superficial femoral arteries outflow- bypass the arterial occlusions at or below the superficial femoral arteries -graft material is sutured above and below the occlusion to facilitate blood flow around the occlusion

causes of angina

- obstruction of coronary blood flow resulting from atherosclerosis, coronary artery spasm, or conditions increasing myocardial oxygen consumption

Spironolactone and digoxin

-In patients taking large doses of spironolactone, a potassium-sparing diuretic, hyperkalemia, and digitalis toxicity may result even at low serum digoxin levels This drug may also interfere with tests to measure digoxin levels in the blood Increases the plasma concentration of digoxin by inhibiting tubular secretion of digitalis and resulting in decreased renal clearance.

swan catheter- pulmonary artery- cardiogenic shock treatment

-assist with insertion of swan catheter (pulmonary artery) to assess degree of heart failure- readings obtained from catheter correlating to cardiogenic shock incude an increased pulmonary capillary wedge pressure and decreased cardiac ouput -monitor distal pulses and maintain the transducer at the level of the right atrium if client has a swan (pulmonary artery) catheter

Assessment for endocarditis

-fever -anorexia -weight loss -fatigue -cardiac murmurs - heart failure -embolic complications from vegetation fragments traveling through the circulation -splinter hemorrhages in the nail beds -osler's nodes (reddish tender lesions) on the pads of the fingers, hands, and toes -Janeway lesions- nontender hemorrhagic lesions on the fingers, toes, nose, or earlobes -splenomegaly

A client experiences initial indications of excitation after having an IV infusion of lidocaine hydrochloride started. The nurse should further assess the client when the client reports having: 1) Palpitations 2) Tinnitus 3) Urinary frequency 4) Lethargy

2) Tinnitus Common adverse effects of lidocaine hydrochloride include dizziness, tinnitus, blurred vision, tremors, numbness and tingling of extremities, excessive perspiration, hypotension, seizures, and finally coma. Cardiac effects include slowed conduction and cardiac arrest. Palpitations, urinary frequency, and lethargy are not considered typical adverse reactions to lidocaine.

How should the nurse instruct the client with unstable angina to use sublingual nitroglycerin tablets when chest pain occurs? "Sit down and then..." 1) Take one tablet every 2-5 minutes until the pain stops." 2) Take one tablet and rest for 15 minutes. Call the physician if pain persists after 15 minutes." 3) Take one tablet, then if the pain persists take additional two tablets in 5 minutes. Call the physician if pain persists after 15 minutes." 4) Take one tablet. If pain persists after 5 minutes call 911."

4) Take one tablet. If pain persists after 5 minutes call 911." The nurse should instruct the client that correct protocol for using sublingual nitroglycerin involves immediate administration when chest pain occurs. Sublingual nitroglycerin appears in the bloodstream within 2-3 minutes and is metabolized within about 10 minutes. The client should sit down and place the tablet under the tongue. If the chest pain is not relieved within 5 minutes, the client should call 911. Although some physicians may recommend taking a second or third tablet spaced 5 minutes apart and then calling for emergency assistance, it is not appropriate to take two tablets at once. Nitroglycerin acts within 2-3 minutes and the client should not wait 15 minutes to take further action. The client should call 911 to obtain emergency help rather than calling the physician.

The nurse notices that a client's heart rate decreases from 63-50 bpm on the monitor. The nurse should first: 1) Administer atropine 0.5mg IV push 2) Auscultate for abnormal heart sounds 3) prepare for transcutaneous pacing 4) Take the client's blood pressure

4) Take the client's blood pressure The nurse should first assess the client's tolerance to the drop in heart rate by checking the blood pressure and level of consciousness and determine if Atropine is needed. If the client is symptomatic, Atropine and transcutaneous pacing are interventions for symptomatic bradycardia. Once the client is stable, further physical assessments can be done.

A patient is seen in the emergency department for a myocardial infarction and cardiogenic shock. The physician assesses the patient for contraindiactions to an intra aortic balloon pump (IABP) Which of the following is an absolute contraindication? 1-Abdominal aortic aneurysm (AAA) 2-Hypertensive crisis 3-Peripheral arterial disease 4-Significant aortic regurgitation

4-Significant aortic regurgitation The IABP works by inflating a balloon inside the descending aorta during diastole to displace blood and increase perfusion to the organs During systole, the balloon rapidly deflates, reducing aortic volume through a vacuum effect and lessening the workload of the heart Absolute contraindications to an IABP include significant aortic regurgitation since the degree of an aortic regurgitation would be increased by the counter-pulsation, pushing the blood back into the left ventricle through the aortic valve each time the balloon inflates the other absolute contraindication is aortic dissection, since the balloon could dissect the aorta completely if it inflated inside the aorta

exercuse electrocardiography testing (stress test)

non-invasive test studies the heart during activity detects and evaluates coronary artery disease treadmill is the most commonly used mode of stress testing if client cant tolerate exercise they are given an IV drip of dipyridamole (persantine), dobutamine hydrochloride or adenosine (adenocard) is given to dilate the coronary arteries and simulate the effects of exercise informed consent is required if a radionuclide is to be injected

postop interventions

vitals monitor bp and notify hcp if changes occur hypotension can indicate hypovolemia hypertension- place stress on graft and cause clot formation maintain bed rest for 24 hours as prescribed instruct client to keep affected extremity straight, limit movement, and avoid bending the knee and hip monitor for warmth, redness,, and edema- increased blood flow graft occlusion- occur within the first 24 hours peripheral pulses- adverse changes in color and temp of extremity encourage coughing, deep breathing- incentive spirometry aseptic technique site bleeding graft hardness, tenderness, and warmth- infection proper foot care SHARP PAIN USUALLY FIRST INDICATOR OF GRAFT OCCLUSION

Nursing considerations for Metoprolol

• Hypertension/angina: ECG directly when giving IV during initial treatment • I&O, weight daily; check for CHF (weight gain, jugular venous distention, crackles, edema, dyspnea) • Monitor B/P during initial treatment, periodically thereafter; pulse q4hr; note rate, rhythm, quality; apical/radial pulse before administration; notify prescriber of any significant changes or pulse <60 bpm • Baselines of renal, hepatic studies before therapy begins

The client is prescribed digoxin for the treatment of heart failure. Which of the following statements made by the client indicates an understanding of the medication regimen?

-i may notice my heart rate decrease -i should notify my physician if i see halos or rings of light around objects -i should seek medical help if i experience palpitations or irregular heartbeat -taking spironolactone may interfere with the accuracy of lab tests to monitor my digoxin levels

The nurse is assessing an older adult with a pacemaker who leads a sedentary lifestyle. The client reports being unable to perform activities that require physical exertion. The nurse should further assess the client for which of the following? 1) Left ventricular atrophy 2) Irregular heartbeats 3)Peripheral vascular occlusion 4) Pacemaker placement

1) Left ventricular atrophy older adults who are less active and do no exercise the heart muscle- atrophy can result Disuse or de-conditioning can lead to abnormal changes in the myocardium of the older adult As a result, under sudden emotional or physical stress, the left ventricle is less able to respond to the increased demands on the myocardial muscle. Decreased cardiac output, cardiac hypertrophy, and heart failure are examples of chronic conditions that may develop in response to inactivity, rather than in response to the aging process. Irregular heart beats are generally not associated with an older sedentary adult's lifestyle. Peripheral vascular occlusion or pacemaker placement should not affect response to stress

When teaching the client about the risks of atrial fibrillation, the nurse should instruct the client to avoid which of the following? 1) Stasis of blood in the atria 2) Increased cardiac output 3) Decreased pulse rate 4) Elevated blood pressure

1) Stasis of blood in the atria Atrial fibrillation occurs when the sinoatrial node no longer functions as the heart's pacemaker and impulses are initiated at sites within the atria. Because conduction through the atria is disturbed, atrial contractions are reduced and stasis of blood in the atria occurs, predisposing to emboli. Some estimates predict that 30% of clients with atrial fibrillation develop emboli. Atrial fibrillation is not associated with increased cardiac output, elevated bp, or decreased pulse rate; rather, it is associated with an increased pulse rate.

The client has had hypertension for 20 years. The nurse should assess the client for: 1) renal insufficiency and failure 2) Valvular heart disease 3) Endocarditis 4) Peptic ulcer disease

1) renal insufficiency and failure Renal disease, including renal insufficiency and failure, is a complication of hypertension. Effective treatment of hypertension assists in preventing this complication.

The nurse is providing discharge teaching to a patient who underwent a coronary artery bypass graft (CABG). Which of the following should the nurse complain is common in the weeks following surgery, but will likely resolve without treatment? 1-Depression 2-Dizziness 3-Edema 4-Nausea

1-Depression Depression is very common after undergoing a CABG. It usually resolves within several weeks after recovery and generally does not require medical intervention. Dizziness may signal a decrease in cardiac output. This is an abnormal finding and requires immediate attention Nausea is not an expected side effect except in weeks following surgery Edema after a CABG may indicate heart failure and should not be ignored

An older adult with a history of hypertension is admitted with diagnosis of dehydration. The client is becoming increasingly confused and weak. The client reports taking one tablet of hydrochlorathiazide (HydroDIURIL) daily, adn the prescription is written for 1/2 tablet. The nurse should obtain additional information about: 1) Decreased drug half- life of the Hydro DIURIL 2) Decreased hepatic blood flow 3) Increased GI activity 4) Increased urinary elimination

2) Decreased hepatic blood flow Aging causes decreased hepatic blood Decreased drug metabolism, which occurs with aging, along with more drug in circulation means the drug will remain in the body longer and produce greater drug effects. The client has also taken more drugs than prescribed increasing the opportunity for more drug action to occur. When there is decreased metabolism of drugs, and increase in the half- life will occurs most especially in the older adult.. In older adults transit time (GI motility) is slower, allowing more drug to be absorbed. Increased urinary elimination would mean that drug elimination could not be higher not lower and accumulating in the body.

The nurse is assessing the hepatojugular reflux in a patient with congestive heart failure. To perform this assessment technique correctly, the nurse should: 1) Compress the abdomen for 5-15 seconds 2) Elevate the head of the bed to 45 degrees 3) Lie the patient flat 4) Press the left upper quadrant of the abdomen

2) Elevate the head of the bed to 45 degrees The hepatojugular reflux test is used to measure jugular vein distention seen in tricuspid regurgitation, heart failure, and other conditions. The nurse places the patient's head at 45 degrees The nurse observes the jugular pulsations during quiet respirations, then firmly presses the right upper quadrant or center of the abdomen for 30-60 seconds The nurse then again observes the jugular pulsations during respirations. If there is a sustained rise in the jugular vein (>3cm), the result is positive

The nurse should teach the client who is receiving warfarin sodium that: 1) Partial thromboplastin time values determine the dosage of warfarin sodium 2) Protamine sulfate is used to reverse the effects of warfarin sodium 3) International Normalized Ratio (INR) is used to assess effectiveness 4) Warfarin sodium will facilitate clotting of the blood

3) International Normalized Ratio (INR) is used to assess effectiveness INR is the value used to assess effectiveness of the warfarin sodium therapy. INR is the prothrombin time ration that would be obtained if the thromboplastin reagent from the World Health Organization was used for the plasma test. It is now the recommended method to monitor effectiveness of warfarin sodium. Generally, the INR for clients administered warfarin sodium should range from 2-3. In the past, prothrombin

Which is the most important initial postprocedure nursing assessment for a client who has had a cardiac catheterization? 1) Monitor the laboratory values 2) Observe neurologic function every 15 minutes 3) Observe the puncture site for swelling and bleeding 4) Monitor skin warmth and turgor

3) Observe the puncture site for swelling and bleeding Assessment of circulatory status, including observation of the puncture site, is of primary importance after a cardiac catheterization. Lab values and skin warmth and turgor are important to monitor but are not the most important initial nursing assessment. Neurologic assessment every 15 minutes is not required.

The nurse is caring for a patient who had a myocardial infarction 3 days ago. The nurse should assess for which abnormal heart sound? 1) Aortic Stenosis 2) Ejection click 3) Pericardial friction rub 4) S4

3) Pericardial friction rub A pericardial friction rub occurs within one week of having an MI due to inflammation of the pericardial sac. It sounds like squeaky leather

As an initial step in treating a client with angina, the physician prescribes nitroglycerin tablets, 0.3 mg given sublingually. The drug's principal effects are produced by: 1) Antispasmodic effects on the pericardium 2) Causing an increased myocardial demand 3) Vasodilation of peripheral vasculature 4) Improved conductivity in the myocardium

3) Vasodilation of peripheral vasculature Nitroglycerin produces peripheral vasodilation, which reduces myocardial oxygen consumption and demand. Vasodilation in coronary arteries and collateral vessels may also increase blood flow to the ischemic areas of the heart. Nitroglycerin does not have an effect on pericardial spasticity or conductivity in the myocardium.

The nurse is assessing a patient with a stable abdominal aortic aneurysm (AAA). The nurse should suspect an extending aneurysm if which finding is noted? 1- bradycardia 2-hypertension 3-right upper quadrant pain that worsens with palpitation 4-worsening back and abdominal pain

4-worsening back and abdominal pain can indicate that the extending aneurysm is pressing against the lumbar nerve root hypotension, tachycardia would be expected with an extension of the AAA

The nurse assesses a patient complaining of chest pain that radiates down the left arm. The patient is diaphoretic and short of breath. What should the nurse do next?

Administer oxygen via nasal cannula, initiate telemetry and check vital signs, and administer nitroglycerin giving nitro to vasodilate the coronary arteries, thus increasing perfusion and improving myocardial delivery of oxygen telemetry is the monitoring of ekg and should be evaluated for possible signs of a myocardial infarction, such as ST segment elevation

A nurse is assessing a client who has left-sided heart failure. Which of the following manifestations should the nurse expect to find? A)Increased abdominal girth B)Weak peripheral pulses C) Jugular venous neck distention D) Dependent edema

B) Weak peripheral pulses Weak peripheral pulses are related to decreased cardiac output resulting from left-sided heart failure Increased abdominal girth is a finding related to systemic congestion resulting from right-sided heart failure Jugular venous neck distention is a finding related to systemic congestion resulting from right-sided heart failure Dependent edema is a finding related to systemic congestion resulting from right-sided heart failure

An elderly client with diabetes who has been maintained on metformin (Glucophage) has been scheduled for a cardiac catheterization. The nurse should verify that the physician has written a prescription to: A) Limit the amount of protein in the diet prior to the cardiac cath B) Withold the Glucophage prior to the cardiac catheterization C) Administer the Glucophage with only a sip of water prior to the cardiac catheterization D) Give the Glucophage before breakfast

B) Withold the Glucophage prior to the cardiac catheterization The nurse should verify that they physician has requested to withhold the Glucophage prior to any procedure requiring dye such as a cardiac catheterization due to the increased risk of lactic acidosis. Additionally, the drug will usually be withheld for up to 48 hours following a procedure involving dye while it clears the client's system. The physician may prescribe sliding scale insulin during this time if needed. Regardless of how or when the medication is administered, the medication should be withheld. The amount of protein in the client's diet prior to the cardiac catheterization has no correlation with medication or the test.

Metoprolol (Lopressor)

Beta- adrenergic blocker indicated for hypertension, angina, and myocardial infarction. The tablets should be taken with food at the same time each day; they should not be chewed or crushed. The health care provider should be notified if pulse falls below 50 for several days. Blood glucose should be checked regularly during therapy since increased episode of hypoglycemia may occurs

Symptoms associated with mitral stenosis

Fatigue (especially with activity), edema in the arms and legs (as right sided heart failure develops) coughing (sputum may be blood-tinged), chest pain, and palpitations A third heart sound may be heard on auscultation, and patients often have a low oxygen saturation even with supplemental O2. It is diagnosed by echocardiography

Contraindications for nitroglycerin

Hypersensitivity to this product or nitrites; severe anemia, increased intracranial pressure, cerebral hemorrhage, closed-angle glaucoma, cardiac tamponade, cardiomyopathy, constrictive pericarditis

How does digoxin work?

Improves cardiac output by slowing and strengthening of contractions

A nurse is instructing a nursing student on performing a 12- lead ekg. Which statement made by the nursing student indicates correct understanding of the precordial lead placement?

V2 is placed on the fourth intercostal space to the left of the sternum V1 is placed on the fourth intercostal space to the right of the sternum V6 is placed on the fifth intercostal space, at the midaxillary line V5 is placed halfway between V4 and V6

A client diagnosed with primary (essential) hypertension is taking chlorothiazide (Diuril). The nurse determines teaching about this medication is effective when the client makes the following statement. "I will..." - Take my weight daily at the same time each day - reduce salt intake in my diet -Use sunscreen if I have prolonged exposure to sunlight

chlorothiazide (Diuril) causes increased urination and decreased swelling (if there is edema) and weight loss. It is important to check and record weight two to three times per week at the same time of day with similar amount of clothing Clients should not drink alcoholic beverages or take other medications without the approval of the healthcare provider. Reducing sodium intake int he diet helps diuretic drugs to be more effective and allows smaller doses to be taken. Smaller doses are less likely to cause adverse effects and hence excessive table salt as well as salty foods should be avoided. It is a diuretic that is prescribed for lower blood pressure and may cause dizziness and faintness when the patient stands up suddenly. This can be prevented or decreased by changing positions slowly. If dizziness is sever, the health care provider must be notified. Diuretics may cause sensitivity to sunlight, use sunscreens, and wear protective clothing. Causes increased urination and must be taken early in the day to decrease nighttime trips to the bathroom. Fewer bathroom trips means less interference with the sleep and less risk of falls.

A nurse is planning a presentation about hypertension for a community women's group. Which of the following lifestyle modifications should the nurse include (Select all that apply) - limited alcohol intake -Regular exercise program -Decreased magensium intake -Reduced potassium intake -Smoking cessation

-limited alcohol intake -regular exercise program -smoking cessation

Metoprolol (Toprol XL) is added to the pharmacologic therapy of a diabetic female diagnosed with stage 2 hypertension initially treated with Furosemide (Lasix) and Ramipril (Altace) An expected therapeutic effect is: 1) Decrease in heart rate 2) Lessening of fatigue 3) Improvement in blood sugar levels 4) Increase in urine output

1) Decrease in heart rate The effect of a beta blocker is a decrease in heart rate, contractility, and after-load, which leads to a decrease in blood pressure. The client at first may have an increase in fatigue when starting the beta blocker .

For a client who excretes excessive amounts of calcium during the postop period after open heart surgery, which of the following measures should the nurse institute to help prevent complications associated with excessive calcium excretion? 1) Ensure a liberal fluid intake 2) Provide an alkaline- ash diet 3) Prevent constipation 4) Enrich the client's diet with dairy products

1) Ensure a liberal fluid intake In an immobilized client, calcium leaves the bone and concentrates in the extracellular fluid. When a large amount of calcium passes through the kidneys, calcium can precipitate and form calculi. Nursing interventions that help prevent calculi include insuring a liberal fluid intake *unless contraindicated* A diet rich in acid should be provided to keep the urine acidic, which increases the solubility of calcium. Preventing constipation is not associated with excessive calcium excretion. Limiting foods rich in calcium, such as dietary products, will help in preventing renal calculi.

A 68 year old client on day 2 after hip surgery has no cardiac history but reports having chest heaviness. The first nursing action should be to: 1) Inquire about the onset, duration, severity, and precipitating factors of the heaviness 2) Administer oxygen via nasal cannula 3) Offer pain medication for the chest heaviness 4) Inform the physician of the chest heaviness

1) Inquire about the onset, duration, severity, and precipitating factors of the heaviness Further assessment is needed in this situation. It is premature to initiate other action s until further data have been gathered. Inquiring about the onset, duration, location, severity, and precipitating factors of the chest heaviness will provide pertinent information to convey to the physician.

After the administration of t-PA, the nurse should 1) Observe the client for chest pain 2) Monitor for fever 3) Review the 12-lead electrocardiogram (ECG) 4) Auscultate breath sounds

1) Observe the client for chest pain Although monitoring the 12-lead ECG and monitoring breath sounds are important, observing the client for chest pain is the nursing assessment priority because closure of the previously obstructed coronary artery may recur. Clients who receive t-PA frequently receive heparin to prevent closure of the artery after administration of t-PA. Careful assessment for signs of bleeding and monitoring of partial thromboplastin time are essential to detect complications. Administration of t-PA should not cause fever.

The physician prescribes continuous IV nitroglycerin infusion for the client with myocardial infarction. The nurse should: 1) Obtain an infusion pump for the medication 2) take the blood pressure every 4 hours 3) Monitor urine output hourly 4) Obtain serum potassium levels daily

1) Obtain an infusion pump for the medication The infusion pump allows for precise control of the medication. Blood pressure monitoring would be done with a continuous system, and more frequently than every 4 hours.

An 85 year old is admitted to the ED at 8pm with syncope, shortness of breath, and reported palipatations (See nurse's notes below). The nurse should do which of the following?

1- Apply oxygen 2- Monitor vital signs 3-Have the client sign consent for cardioversion as prescribed The client has atrial fibrillation and will have an irregularly irregular pulse and will be tachycardic, with rapid ventricular responses (heart rates) typically in the 110-140 range, but rarely over 150 to 170. The goal of treatment is the restoration of sinus rhythm. With a heart rate greater than 150 and symptoms such as shortness of breath, dizziness, and syncope, and chest pain, synchronized cardioversion will most likely be the treatment of choice. With more controlled heart rates and more minor signs and symptoms, chemical cardioversion with drugs such as Cardizem and Digitalis (Digoxin) prior to other interventions such as synchronized cardioversion with appropriate anti-coagulation may be attempted. Because of the decreased cardiac output, monitoring is essential. Obtaining consent for cardioversion requires a prescription from a health care provider, but with the current heart rate, having cardioversion is a very strong possibility for this client. Defibrillation is used for ventricular fibrillation, not atrial fibrillation.

While caring for a client who has sustained a myocardial infarction (MI), the nurse notes eight premature ventricular contractions (PVCs) in 1 minute on the cardiac monitor. The client is receivng an IV infusion of 5% dextrose in water (D5W) and oxygen at 2L/ min. The nurse's first course of action should be to: 1) Increase IV infusion rate 2) Notify the physician promptly 3) Increase the oxygen concentration 4) Administer a prescribed analgesic

2) Notify the physician promptly PVCs are often a precursor of life threatening arrhythmias including v tach and v fib. An occasional PVC is not considered dangerous, but if PVCs occur at a rate greater than five or six per minute in the post MI client, the physician should be notified immediately. More than six PVCs per minute is considered serious and usually calls for decreasing ventricular irritability by administering medications such as lidocaine hydrochloride.

Which of the following is an expected outcome for a client on the second day of hospitalization after an MI? The client: 1) Continues to have severe chest pain 2) Can identify risk factors for MI 3) Participates in a cardiac rehabilitation walking program 4) Can perform personal self-care activities without pain

4) Can perform personal self-care activities without pain By day 2 of hospitalization after an MI, clients are expected to be able to perform personal care without chest pain. Severe chest pain should not be present on day 2 after an MI. Day 2 of hospitalization may be too soon for clients to be able to identify risk factors. Te client may be sitting up in a chair as a part of the cardiac rehab program.

The nurse teaches a client with heart failure to take oral furosemide in the morning. The primary reason for this is to help: 1) Prevent electrolyte imbalances 2) Retard rapid drug absorption 3) Excrete excessive fluids accumulated during the night 4) Prevent sleep disturbances during the night

4) Prevent sleep disturbances during the night When diuretics are given early in the day, the client will void frequently during the daytime hours and will not need to void frequently during the night. Therefore, the client's sleep will not be disturbed. Taking furosemide in the morning has no effect on preventing electrolyte imbalances or retarding rapid drug absorption. The client should not accumulate excessive fluids throughout the night.

The nurse is caring for a client who recently experienced a myocardial infarction and has been started on clopidogrel (Plavix). The nurse should develop a teaching plan that includes which of the following points? Select all that apply: A) The client should report unexpected bleeding or bleeding that lasts a long time B) The client should take Plavix with food C) The client may bruise more easily and may experience bleeding gums D) Plavix works by preventing platelets from sticking together and forming a clot E) The client should drink a glass of water after taking Plavix

A) The client should report unexpected bleeding or bleeding that lasts a long time C) The client may bruise more easily and may experience bleeding gums D) Plavix works by preventing platelets from sticking together and forming a clot Plavix is generally well absorbed and may be taken with or without food; it should be taken at the same time every day and, while food may help prevent GI upset, food has no effect on absorption of the drug. Bleeding is the most common adverse effect of Plavix; the client must understand the importance of reporting an unexpected, prolonged, or excessive bleeding including blood in urine or stool. Increased bruising and bleeding gums are possible side effects of Plavix; the client should be aware of this possibility. Plavix is an antiplatelet agent used to prevent clot formation in clients that have experienced or are at risk for myocardial infarction, ischemic stroke, peripheral artery disease, or acute coronary syndrome.

A nurse is providing discharge teaching for a client who has heart failure. The nurse should instruct the client to report which of the following findings immediately to the provider? A) Weight gain of 0.9kg (2lb) in 24 hours B) Increase of 10 mm Hg in systolic BP C) Dyspnea with exertion D) Dizziness when rising quickly

A) Weight gain of 0.9kg (2lb) in 24 hours When using the urgent vs. nonurgent approach to client care, the nurse should determine that the priority finding is a weigh gain of 0.5-0.9kg (1-2 lb) in 1 day. This weight gain is indication of fluid retention resulting from worsening heart failure. The client should report this finding immediately. An increase of 10 mmHg in systolic bp is a nonurgent finding- althought he client should note the increase in bp, the client does not need to report this finding immediately. Dyspnea with exertion is a non-urgent finding, and the client does not need to report it immediately Dizziness when rising quickly is a non-urgent finding that is expected for a client who is taking medications to treat heart failure. The client does not need to report this finding immediately.

A nurse is assessing a client in the emergency room who has bradydysrhythmia. Which of the following findings should the nurse expect? A) confusion B)friction on rub C) hypertension D) dry skin

A) confusion- bradydysrhythmia can cause decreased tissue perfusion, which can lead to confusion. Therefore, the nurse should monitor the client's mental status The nurse should expect to hear a friction rub during cardiac auscultation on a client who has pericarditis The nurse should monitor the client who has a bradydysrhythmia for hypotension The nurse should monitor the client who has a bradydysrhythmia for diaphoresis

A nurse is caring for a client following insertion of a permanent pacemaker. Which of the following client statements indicates a potential complication of the insertion procedure A) hiccups B) dizziness upon standing C) stinging at the incision site D) headache

A) hiccups- can indicate that the pacemaker is stimulating the chest wall or diaphragm, which can indicate a complication such as lead wire perforation Dizziness is not a complication of the insertion procedure and can be expected initially as the client adjusts to the pacemaker Pain or stinging at the incision site is an expected finding after insertion of a permanent pacemaker Headache is not a complication of the insertion procedure. However, it might be related to other disease processes.

A client who has been given CPR is transported by ambulance to the hospital's emergency department, where the admitting nurse quickly assesses the client's condition. The most effective way to determine the effectiveness of CPR is noting whether the: A) Pulse rate is normal B) Pupils are reacting to light C) Mucous membranes are pink D) Systolic blood pressure is at least 80 mm Hg.

B) Pupils are reacting to light Pupillary reaction is the best indication of whether oxygenated blood has been reaching the client's brain, Pupils that remain widely dilated and do not react to light probably indicate that serious brain damage has occurred. The pulse rate may be normal, mucous membranes may still be pink, and systolic blood pressure may be 80 mm Hg or higher, and serious brain damage may still have occurred.

Nursing Considerations

Assess: • Pain: duration, time started, activity being performed, character • Orthostatic B/P, pulse before and after administration • Tolerance if taken over long period • Headache, lightheadedness, decreased B/P; may indicate a need for decreased dosage Evaluate: • Therapeutic response: decrease, prevention of anginal pain Teach patient/family: • To place buccal tab between lip and gum above incisors or between cheek and gum • To keep tabs in original container; to replace q6mo because effectiveness is lost; to keep away from heat, moisture, light • That if 3 SL tabs in 15 min do not relieve pain, to seek immediate medical attention • To avoid alcohol • That product may cause headache; that tolerance usually develops; to use nonopioid analgesic • That product may be taken before stressful activity: exercise, sexual activity • That SL may sting when product comes in contact with mucous membranes • To avoid hazardous activities if dizziness occurs • To comply with complete medical regimen • To make position changes slowly to prevent fainting Never to use erectile dysfunction products (sildenafil, tadalafil, vardenafil); may cause severe hypotension, death

A nurse is providing health teaching for a group of clients. Which of the following clients is at risk for developing peripheral arterial disease? A) A client who has hypothyroidism B) A client who has diabetes mellitus C) A client whose daily caloric intake consists of 25% fat D) A client who consumes two bottles of beer a day

B) A client who has diabetes mellitus diabetes mellitus places the client at risk for microvascular damage and progressive peripheral arterial disease Hypothyroidism is not associated with peripheral arterial disease Twenty-five percent is within the recommended range for daily fat intake and diet does not place the client at risk for development for peripheral arterial disease Two bottles of beer a day is considered moderate alcohol intake and does not place the client at risk for development of peripheral arterial disease

During physical assessment, the nurse should further assess the client for signs of atrial fibrillation when palpation of the radial pulse reveals: A) Two regular beats followed by one irregular beat B) An irregular rhythm with pulse rate greater than 100 C) Pulse rate below 60 bpm D) A weak, thready pulse

B) An irregular rhythm with pulse rate greater than 100 Characteristics of atrial fibrillation include pulse rate greater than 100 bpm, totally irregular rhythm, and no definite P waves on the ECG. During assessment, the nurse is likely to note the irregular rate and should report it to the physician. A weak thready pulse is characteristics of a client in shock. Two regular beats followed by an irregular beat may indicate a premature ventricular contraction.

A nurse is caring for a client in the first 8 hr following coronary bypass graft (CABG) surgery. Which of the following client findings should the nurse report to the provider? A) Mediastinal drainage 100mL/ hr B) Blood pressure 160/80 mm Hg C) Temperature 37.1C (98.8F) D) Potasium 3.8 mEq/ L

B) Blood pressure 160/80 mm Hg) - the nurse should report an elevated bp following a CABG procedure because increased vascular pressure can cause bleeding at the incision sites Mediastinal drainage of up to 150 mL/ hr is expected during this time A body temperature within the expected reference range is anticipated following a CABG procedure A potassium level of 3.8 mEq/ L is within the expected reference range

A nurse is caring for a client who is being treated for heart failure and has prescriptions for digoxin and furosemide. The nurse should plan to monitor for which of the following as an adverse effect of these medications? A) Shortness of breath B) Lightheadedness C)Dry cough D) Metallic taste

B) Lightheadedness Furosemide can cause a substantial drop in blood pressure, resulting in lightheadedness Digoxin and furosemide are used to manage shortness of breath secondary to heart failure. This is not an adverse reaction to these medications A dry cough is not an adverse reaction to digoxin and furosemide A metallic taste is not an adverse reaction to digoxin and furosemide

A client who has a new diagnosis of hypertension has a prescription for an ACE inhibitor. The nurse instructs the client about adverse effects of medication. The client demonstrates an understanding of the teaching by stating that he will notify his provider if he experiences which of the following? A) tendon pain B) persistent cough C) Frequent urination D) Constipation

B) Persistent cough- an adverse effect of ACE inhibitors, and the client should discontinue the medication if it occurs Frequent urination is an expected outcome of this medication Constipation is a common adverse effect of calcium- channel blockers, but is not an adverse effect of ace inhibitors

A nurse is providing discharge teaching for a client who has a prescription for the transdermal nitroglycerin patch. Which of the following instructions should the nurse include in the teaching? A) Apply the new patch to the same site as the previous patch B) Place the patch on an area of skin away from skin folds and joints C) Keep the patch on 24 hr per day D) Replace the patch at the onset of angina

B) Place the patch on an area of skin away from skin folds and joints -The client should apply the patch to an area of skin that is not prone to movement of wrinkling Rotating the patch site can help prevent skin irritation The client should have a patch-free interval of 10-12 hours per day to help prevent tolerance to this medication The nurse should emphasize that nitroglycerin patches offer ongoing prevention of angina attacks. The patches do not treat angina attacks because they do not take effect immediately.

A nurse is watching a client's ECG monitor and notes that the client's rhythm has changed from a normal sinus rhythm to supraventricular tachycardia. The client is conscious with a heart rate of 200-210/ min and has a faint radial pulse. The nurse should anticipate assisting with which of the following interventions? A) Delivery of a precordial thump B) Vagal stimulation C) Administration of atropine IV D) Defibrillation

B) Vagal stimulation- can help the client's heart return to a normal sinus rhythm temporarily Supraventricular tachycardia does not require a precordial thump Supraventricular tachycardia does not require atropine Supraventricular tachycardia does not require defibrillation

A nurse admitting a client who has a leg ulcer and a history of diabetes mellitus. The nurse should use which of the following focused assessments to help differentiate between an arterial ulcer and a venous stasis ulcer? A) Explore the client's family history of peripheral vascular disease B) Note the presence or absence of pain at the ulcer site C) Inquire about the presence or absence of claudication D) Ask if the client has had a recent infection

C) Inquire about the presence or absence of claudication Knowing if the client is experiencing claudication helps differentiate venous from arterial ulcers. Clients who have arterial ulcers experience claudication, but those who have venous ulcers do not. Family history is important, but it does not help to differentiate between arterial and venous ulcers Both arterial and venous ulcers cause varying degrees of pain or discomfort Both arterial and venous ulcers have the potential to become infected

A nurse is caring for a client who presents to the emergency department with a blood pressure of 254/139 mmHG. The nurse recognizes that the client is in a hypertensive crisis. Which of the following actions should the nurse take first? A) Obtain blood sample for lab testing B)Tell the client to report vision changes C) Place the head of the bed at 45 degrees D) Initiative an IV

C) Place the head of the bed at 45 degrees The first action the nurse should take when using the airway, breathing, circulation approach to client care is to place the bed at 45 degrees. This improves respiratory status and promotes venous return to reduce workload on the heart. The nurse should obtain blood samples for lab testing, such as cholesterol and glucose. However, this is not the first action the nurse should take. The nurse should tell the client to report vision changes as part of monitoring for the complications of hypertension, however, this is not the first action the nurse should take.

The client who had a permanent pacemaker implanted 2 days earlier is being discharged from the hospital. The client understands the discharge plan when the client: A) Selects a low- cholesterol diet to control coronary artery disease B) States a need for bed rest 1 week after discharge C) Verbalizes safety precautions needed to prevent pacemaker malfunction. D) Explains signs and symptoms of a myocardial infarction (MI)

C) Verbalizes safety precautions needed to prevent pacemaker malfunction. Education is a major component of the discharge plan for a client with an artificial pacemaker. The client with a permanent pacemaker needs to be able to state specific information about safety precautions, such as to refrain from lifting more than 3 lb (1.35kg) or stretching and bending and to count the pulse once per week, that are necessary to maintain proper pacemaker function.

The nurse should teach the client that signs of digoxin toxicity include which of the following? A) Rash over the chest and back B) Increased appetite C) Visual disturbances such as seeing yellow spots D) Elevated blood pressure

C) Visual disturbances such as seeing yellow spots Colored vision and seeing yellow spots are other common symptoms of digoxin toxicity. Abdominal pain, anorexia, nausea, and vomiting are other common symptoms of digoxin toxicity. Additional signs of toxicity include arrhythmias, such as atrial fibrillation or bradycardia. Rash, increased appetite, and elevated bp ARE NOT associated with dogixin toxicitiy

Side Effects of Metoprolol

CNS: Insomnia, dizziness, mental changes, hallucinations, depression, anxiety, headaches, nightmares, confusion, fatigue CV: Hypotension, bradycardia, CHF, palpitations, dysrhythmias, cardiac arrest, AV block, pulmonary/peripheral edema, chest pain EENT: Sore throat; dry, burning eyes GI: Nausea, vomiting, colitis, cramps, diarrhea, constipation, flatulence, dry mouth, hiccups GU: Impotence Hema: Agranulocytosis, eosinophilia, thrombocytopenia, purpura Integ: Rash, purpura, alopecia, dry skin, urticaria, pruritus Resp: Bronchospasm, dyspnea, wheezing

Cardizem- Diltiazem

Calcium channel blocker and anti-hypertensive drug It can treat high blood pressure and chest pain (angina). Decrease cardiac contractility- negative inotropic effect by relaxing the smooth muscle and reduce the workload of the heart by reducing the need for oxygen Used for angina, dysrythmias, or hypertension- should be used with caution in the client with heart failure, bradycardia, or av block

A client is admitted to the hospital for evaluation of recurrent episodes of ventricular tachycardia as observed on Holter monitoring. The client is scheduled for electrophysiology studies (EPS) the following morning. Which statement should the nurse include in a teaching plan for this client. A) "You will continue taking your medications until the morning of the test" B) "You might be sedated during the procedure and will not remember what has happened." C) "This test is a noninvasive method of determining the effectiveness of your medication regimen." D) "During the procedure, the doctor will insert a special wire to increase the heart rate and produce irregular beats that caused your signs and symptoms."

D) "During the procedure, the doctor will insert a special wire to increase the heart rate and produce irregular beats that caused your signs and symptoms." The purpose of the EPS studies is to study the heart's electrical system. During this invasive procedure, a special wire is introduced into the heart to produce dysrhythmia. To prepare for this procedure, the client should be NPO for 6-8 hours before the test, and all anti-dysrhythmics are held for at least 24 hours before the test in order to study the dysrhythmia without the influence of medications. Because the client's verbal responses to the rhythm changes are extremely important, sedation is avoided if possible.

A nurse is caring for a client who has a history of deep vein thrombosis and is receiving warfarin. Which of the following client findings provides the nurse with the best evidence regarding the effectiveness of the warfarin therapy? A) Hemoglobin 14 g/ dL B) Minimal bruising of extremities C) Reduced circumference of affected extremity D) INR 2.5

D) INR 2.5- The nurse should determine that an INR of 2.5 is within the desired therapeutic range and is the best evidence of effective warfarin therapy The nurse should recognize a hemoglobin level of 14g/ DL is within the expected reference range and is desired. However, this is not the best evidence of effective warfarin therapy The nurse should recognize that minimal bruising or no bruising is desired. However, this is not the best evidence of effective warfarin therapy The nurse should recognize that decreased circumference of the affected extremity is a desired effect. However, this is not the best evidence of effective warfarin therapy.

The client is scheduled for a percutaneous transluminal coronary angioplasty (PTCA) to treat angina. Priority goals for the client immediately after PTCA should include: A) Minimizing dyspnea B) Maintaining adequate blood pressure C) Decreasing myocardial contractility D) Preventing fluid volume deficit

D) Preventing fluid volume deficit Because contrast medium used in PTCA acts as an osmotic diuretic, the client may experience diuresis with resultant fluid volume defect. after the procedure. Additionally, potassium levels must be closely monitored because the client may deelop hypokalemia due to the diuresis. Dyspnea would not be anticipated after this procedure. Maintaining adequate blood pressure control should not be a problem after the procedure. Increased myocardial contractility would be a goal, not decreased contractility.

A nurse is caring for a client following an abdominal aortic aneurysm reaction. Which of the following is the priority assessment for this client? A) Neck vein distention B) Bowel sounds C) Peripheral edema D) Urine Output

D) Urine output- the greatest risk to this client is graft occlusion or rupture. Therefore, monitoring urine output, which reflects blood flow to the kidneys, is the priority assessment The client is at risk for neck vein distention because of hypervolemia, but it is not the priority assessment The client is at risk for reduced bowel sounds because of the reduced perfusion but it is not the priority assessment The client is at risk for peripheral edema because of reduced cardiac output, but it is no the priority assessment

Nitroglycerin SL

Nitroglycerin reduces the pain of exertional angina primarily by reducing cardiac oxygen demand. By dilating veins, nitroglycerin reduces venous return to the heart, thereby reducing ventricular filling. The resultant decrease in wall tension (preload) reduces oxygen demand. In patients with variant angina, nitroglycerin acts by relaxing or preventing spasm in the coronary arteries, increasing the oxygen supply. • Nitroglycerin is highly lipid soluble and crosses membranes with ease. It undergoes rapid inactivation by hepatic enzymes (organic nitrate reductases). Consequently, the drug has a plasma half-life of only 5 to 7 minutes. • Nitroglycerin is generally well tolerated. Principal adverse effects—headache, hypotension, and tachycardia—occur secondary to vasodilation. • By lowering the blood pressure, nitroglycerin can activate the baroreceptor reflex, causing sympathetic stimulation of the heart (reflex tachycardia). The resultant increase • Adult: SL Dissolve tab under tongue when pain begins; may repeat q5min until relief occurs; take ≤3 tabs/15 min; use 1 tab prophylactically 5-10 min before activities; SUS CAP q6-12hr on empty stomach; TOP 1-2 in q8hr, increase to 4 in q4hr as needed; IV 5 mcg/min then increase by 5 mcg/min q3-5min; if no response after 20 mcg/min, increase by 10-20 mcg/min until desired response; TRANS PATCH apply a pad daily to a site free of hair; remove patch at bedtime to provide 10-12 hr nitrate-free interval to avoid tolerance

A nurse is caring for a client who has endocarditis, Which of the following findings should the nurse recognize as a potential complication? A) Ventricular depolarization B)Guillain- Barre syndrome C)Myelodysplastic syndrome D)Valvular disease

Valvular disease or damage often occurs as a result of inflammation or infection of the endocardium Ventricular depolarization occurs during a normal cardiac cycle and is not a potential complication of endocarditis Guillain Barre syndrome is not a potential complication of endocarditis Myelodysplastic syndrome is not a potential complication of endocarditis

Adenosine- Adenosine (Adenocard)

Used for PSVT, WPW syndrome 6 mg rapid IV over 1-3 sec followed by 20-mL saline flush; repeat in 1-2 min at 12 mg IV over 1-3 sec with 20-mL flush Monitor heart rate and rhythm after administration. A short period of asystole is common after administration; bradycardia and hypotension may occur. Assess patients for facial flushing, shortness of breath, dyspnea, and chest pain. These side effects commonly occur. Assess patients for recurrence of PSVT or ventricular ectopy. Recurrence of PSVT is common; PVCs may occur.

Metoprolol- teach patient/ family

• Not to use OTC products containing α-adrenergic stimulants (nasal decongestants, OTC cold preparations) unless directed by prescriber; to avoid alcohol, smoking, sodium intake • To report bradycardia, dizziness, confusion, depression, fever, sore throat, SOB, decreased vision to prescriber • To take pulse, B/P at home; when to notify prescriber • To comply with weight control, dietary adjustments, modified exercise program • To carry emergency ID to identify product, allergies • To monitor blood glucose closely if diabetic • To avoid hazardous activities if dizziness is present • To report symptoms of CHF: difficult breathing, especially on exertion or when lying down; night cough; swelling of extremities • To wear support hose to minimize effects of orthostatic hypotension • To report Raynaud's symptoms • To take immediately after meals; to take medication at bedtime to prevent effect of orthostatic hypotension